License Application Forms

Instructions for completing and submitting the
forms required for licensure appear below. You may also need to submit
additional information (for example, examination scores). Please refer
to the license requirements link on the left for complete information regarding
all requirements you must meet.

Note: All forms are in Adobe Portable Document Format (PDF). To view
or print these documents, you will need to have the
free Adobe Reader installed
on your computer. Download times and print quality will depend on your
connection speed and printer.

Important Notice: A New York State professional license is valid for life unless it is revoked, annulled, or suspended by the Board of Regents. To practice in New York State your professional license must be registered. If your registration has lapsed and you need to reregister, do not submit a Form 1. Instead, contact the Registration and Fees Unit to request a Delayed Registration Application by e-mailing: OPREGFEE@nysed.gov, or by calling 518-474-3817 Ext. 410. When e-mailing, be sure to include your profession, license number, address on record, new address (if changed), date of birth and the last 4 digits of your SSN.

All applicants for licensure must complete this form and submit it
with the $294 licensure and registration fee for Respiratory Therapist
or $154 for Respiratory Therapy Technician directly to the Office of
the Professions at the mailing address at the end of Form 1. Make checks
payable to the New York State Education Department. NOTE: Your cancelled
check is your receipt.

You must answer all questions and provide all information requested
unless otherwise indicated. Failure to complete all required
parts of the application will delay its review. Your signature on Form
1 must be notarized by a notary public.

Section I: Complete this section of the
form before sending it to your school. Please be sure to
sign and date item 9.

Section II: The Registrar or appropriate
school official must complete this section and return the
form directly to the Office of the Professions at the address at the
end of the form. For graduates of NYS licensure qualifying or CoARC
accredited programs, Part B, Section I must be completed. For graduates
of non-NYS licensure-qualifying or non-CoARC accredited programs and
for technician graduates applying for licensure in respiratory therapy,
Part B, Section II must be completed and official transcripts and
other needed documents submitted.

Section I: Complete this section
of the form. Please be sure to sign and date item 9.

Section II: Your prospective
employer must complete this section. You must meet all other
requirements for licensure except the examination requirement,
in order to be eligible for a limited permit.

In addition to the Form 5 and fee, you must also submit
the Application for Licensure (Form
1), the licensure fee, and have the State Education Department
approve your education before your application for a limited
permit can be approved. Return the completed Form 5 to
the Office of the Professions at the address at the end
of the form.